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“Mama Might Be Better Off Dead” by Laurie K Abraham


Mama Might Be Better Off Dead is written by Laurie K Abraham (1994) and depicts a profound and unsettling picture of health care from the human perspective. The book is illuminating as also disturbing in telling the story of the devastating illnesses which have become very common in the inner cities of America. The depiction is in the nature of immersing the reader into the lives of a poor African American family that is beset with severe illness related problems. The author has portrayed in a powerful manner the vicious circle of illness and poverty by detailing the account of a black family that is uninsured. The family has four generations living together in Chicago in one of its sickest and poorest localities and is confronted with a number of medical misfortunes. The book is in the nature of a lucid chronicle which is personally observed by the author and calls for reforms in the poorly managed health care system in the country. It deserves to be scrutinized by the health service authorities so that adequate reforms are introduced in setting fresh limits on spending in the health care sector.

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The intention of the author is to convey that although minimal health care facilities are available to the public they tend to come late in an episodic manner and are often made available in limited settings only, such as hospital emergency rooms. There are extreme uncertainties and inconveniences faced and Abraham (1994) narrates without any hitch that the stigma of the underprivileged constitutes a major barrier to the access of health care facilities.

In narrating the story of a particular family, Abraham (1994) has indirectly addressed the risks that are being increasingly faced by a growing number of middle class families in America, especially in the context of the increasing wave of declining insurance covers. The book particularly addresses the prevalent danger to the recently evolved changes in health care in the country resulting from a comprehensive change in facilities for health care as emanating from proposals in using reforms in insurance.

The story is plotted in North Lawndale which is a neighborhood in the suburbs of Chicago. The locality is privileged in being surrounded with several medical facilities that are considered to be the best in the city, but it is unfortunately very sick and has come to become the most undeserved medical community in the entire country. The family is headed by Jackie Banes who has to take care of her drug addicted husband who is on dialysis for kidney complications, a partially stroke paralyzed son, a grandmother who is diabetic, a sick father and children who desperately require immunization and primary care. The Banes family is suffering from several medical crises and much of their time is spent in emergency visits to dialysis facilities and other health care facilities in hospitals. They have to keep making trials with medical care at home and struggle to become eligible for Medicaid under the adverse circumstances that they are already passing through. Abraham (1994) has given an exhaustive account of their suffering in regard to access and at times lack of access to medical care by the Banes family.

The story of the Banes family is narrated rather sympathetically but lacks the inherent sentiments that go with the poverty stricken circumstances of the family. The story clearly reveals the inadequacy of the health care system in urban America which is further weakened by the adverse consequences of penury and deprivation. Upon reading the book one realizes that when a person is poor he falls ill very easily and then his family also goes into hardship and distress.

Within the pages of the book one just cannot miss amidst the family narratives the clear analysis of the inequalities, inconsistencies and gaps that have become integral to what the deprived population has to face in seeking health care facilities. The book succinctly reveals the kind of health care programs that are created in Washington D. C and other capitals of the country’s states so as to make them appear to meet the medical and health care needs of the public at large. The intricacies involved by way of the catchy situations underlined in Medicare and Medicaid are detailed in the book in making people aware of the practical difficulties faced in getting treatment, especially at a time when the families of terminally ill patients are running from pillar to post to get relief by way of treatment and funding. The book also reveals the inherent practices in hospital financing, the racial approach into politics of organ transplant and the ineffectiveness of programs for child hood immunization. The annoying issues of institutional paternalism and individual responsibilities have been effectively examined in the book. The conclusion in the book is clear that the poor family does not get all that it is entitled to get under the provisions of the health care system.

Abraham (1994) has very skillfully woven the different themes together in making a convincing argument for reforms in health care while at the same time steadfastly presenting the difficulties and complications that will prove to be hurdles in bringing about the required changes. Mama Might Be Better Off Dead is a book that has the potential to alter the ways in which the health care system is understood in the United States. It is of particular use to those that seek to learn the present status of the American health care system, what it delivers and what it promises. The book provides a strong ground to initiate debates in bringing about health care reforms in the country.

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Abraham (1994) closes her book with some recommendations in addressing the medical sociology issues to give direction to national health reforms in the country. She has called for a new vision that looks at limiting the continual pursuit of curing at the cost of caring. One can also understand from her case analysis the different practical policy suggestions that relate to specialist financial aid packages to hospitals in the inner city and to giving subsidies to primary care clinics that cater to the needs of the poor. She has also stressed the need to arrange for health providers training in areas that are under served and to provide complete mental healthcare facilities, higher standards of public health service and development of delivery and coordinated health care management structures.


Laurie Kaye Abraham, Mama Might Be Better Off Dead, 1994, University of Chicago Press.

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